Provider Demographics
NPI:1790666808
Name:BUONADONNA, DOMENIC (LAC)
Entity type:Individual
Prefix:MR
First Name:DOMENIC
Middle Name:
Last Name:BUONADONNA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 STATE ROUTE 79 N
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1157
Mailing Address - Country:US
Mailing Address - Phone:732-307-0205
Mailing Address - Fax:
Practice Address - Street 1:281 STATE ROUTE 79 N
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1157
Practice Address - Country:US
Practice Address - Phone:732-307-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00860900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health